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Arch Iran Med. April 2020;23(4):268-271

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doi 10.34172/aim.2020.09 http://www.aimjournal.ir MEDICINE
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Epidemiology and Clinical Characteristics of COVID-19

Xiaoyi Huang, MM1#; Fengxiang Wei, PhD2#; Liang Hu, MM2; Lijuan Wen, MM2; Ken Chen, MM1*

1
School of Nursing, Guangdong Pharmaceutical University, 283 Jianghai Avenue, Haizhu District, Guangzhou, China
2
Shenzhen Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen 518172, China

Abstract
Since December 2019, there has been an outbreak of a novel coronavirus (COVID-19) infection in Wuhan, China. Meanwhile, the
outbreak also drew attention and concern from the World Health Organization (WHO). COVID-19 is another human infectious
disease caused by coronavirus. The transmission of COVID-19 is potent and the infection rate is fast. Since there is no specific
drug for COVID-19, the treatment is mainly symptomatic supportive therapy. In addition, it should be pointed out that patients
with severe illness need more aggressive treatment and meticulous care. Recently, accurate RNA detection has been decisive
for the diagnosis of COVID-19. The development of highly sensitive RT-PCR has facilitated epidemiological studies that provide
insight into the prevalence, seasonality, clinical manifestations and course of COVID-19 infection. In this review, we summarize
the epidemiology and characteristics of COVID-19.
Keywords: COVID-19 virus, Epidemiology, Review
Cite this article as: Huang X, Wei F, Hu L, Wen L, Chen K. Epidemiology and clinical characteristics of COVID-19. Arch Iran Med.
2020;23(4):268–271. doi: 10.34172/aim.2020.09.

Received: March 3, 2020, Accepted: March 21, 2020, ePublished: April 1, 2020

Introduction complete yet. In this review, we review the epidemiology

In early December 2019, an outbreak of unexplained
pneumonia occurred in Wuhan, Hubei Province.1-2 Since
the outbreak of the new coronavirus pneumonia, with the
rapid spread in the country and even the world, the number
of infected cases has grown exponentially. The rapid spread
of COVID-19 has attracted worldwide attention, and the
World Health Organization (WHO)1, 3 has identified it
as a public health emergency of international concern.
The incubation period for this disease is generally 1−14
days.4 The disease usually begins with simple respiratory
symptoms described as fever and cough for 2−3 days.
Human challenge studies confirmed that COVID-19
causes upper respiratory disease and immune responses.
Recent developments in RT-PCR for COVID-19
detection have given rise to a greater understanding of
the clinical characteristics and molecular epidemiology of
COVID-19.5 Since most of the patients with the earliest
onset had been exposed to the south China seafood
market in Wuhan, it was widely believed that COVID-19
originated from wild animals sold in the market. Shi et
al6 reported that the natural host of COVID-19 might
be bats; the team found that the full genome sequence
of the COVID-19 obtained from the confirmed patient
was 96% similar to the bat coronavirus, and it was also
demonstrated that COVID-19 acts on the receptor
angiotensin-converting enzyme 2 through the same cells
as severe acute respiratory syndrome coronavirus (SARS-
CoV). However, the relevant research on COVID-19 is not
and clinical characteristics of COVID-19.
Virus Forms and Structure
The coronavirus is a single-stranded RNA virus with
a diameter of 80 ~120 nm. It consists of four types,
namely α-CoV, β-CoV, δ-CoV and γ-CoV.7 Bats are the
most important natural hosts. About 35% of the viruses
they carry are coronaviruses, from which at least a dozen
different coronaviruses have been identified so far.8 The
COVID-19 was a novel class coronavirus with a circular
or elliptic shape and a diameter of 60-140 nm.7-9 The
typical coronavirus particle structure was observed under
electron microscopy. Current studies have shown a 96.3%
homology with the bat SARS-like coronavirus (BatCoV
RaTG13), suggesting that bats may be the natural host for
COVID-19.
Epidemiological and Clinical Characteristics
Methods of Detection
Seropositive studies provide key insight into the
epidemiology of COVID-19, but there are limitations
including the limited ability to determine the time of
infection. This makes it difficult to identify and count
mild and asymptomatic infections.10
Seroepidemiology
Previous studies have shown that viral RNA can be
found in the plasma or serum of patients with SARS-

#
Xiaoyi Huang and Fengxiang Wei contributed equally to this work.
*Corresponding Author: Ken Chen, MM; School of Nursing, Guangdong Pharmaceutical University, 283 Jianghai Avenue, Haizhu District, Guangzhou, China.
Email: chenkenck@126.com
Epidemiological characteristics of COVID-19
COV, MERS-COV or SARS-COV-2 at different periods
after the onset of disease.11 However, polymerase chain
reaction (PCR) detection of viral RNA is not equivalent
to detection of a complete infectious virus.12 As more and
more asymptomatic infections are found in COVID-19
cases, blood safety should be considered. At the same
time, current studies suggest that people are generally
susceptible to COVID-19, and the severity of COVID-19
is positively correlated with age and underlying diseases
(hypertension, diabetes, cardiovascular disease, etc.),
which is similar to the situation with SARS and Middle
East respiratory syndrome (MERS) infection. To sum
up, COVID-19 has strong transmission capacity and a
large base of susceptible population. So, it is necessary
to take actions as soon as possible to avoid larger scale
spread. The final cause of death for many patients may
be acute respiratory distress syndrome, according to the
chief export of the acute respiratory care department at
Zhongnan hospital of Wuhan university.3 For COVID-19,
people of all ages, with or without immunity, may progress
to the critical stage of acute respiratory distress syndrome.
Admittedly, the mechanics of ARDS are unclear. Since
there is no specific drug for COVID-19, treatment is
concentrated on symptomatic support. In addition, it is
important to emphasize that severe patients need more
aggressive treatment and meticulous care.
COVID-19 in Adults
At the same time, current studies suggest that the
population is generally susceptible to COVID-19, and the
severity of the disease is positively correlated with age and
underlying diseases (hypertension, diabetes, cardiovascular
disease, etc.) This is similar to what happened with SARS
and MERS. Huang et al1 reported the first 41 cases of
COVID-19 diagnosed in Wuhan, among which 27 cases
(66%) had a history of exposure to the seafood market in
southern China, and one case had familial clustering. This
report first mentioned that COVID-19 may have human-
to-human transmission characteristics. Subsequently, Chen
et al12 observed 99 patients with COVID-19 in the same
hospital, and found that elderly men with close contacts
and underlying diseases were more likely to be infected,
which could rapidly progress to severe respiratory diseases
such as acute respiratory distress syndrome (ARDS) and
even become life-threatening.
COVID-19 in Children
A number of studies have focused on pediatric
populations. As children’s immune function is not mature,
they are susceptible to respiratory system infections, and
their symptoms are more diversified, so the formation of
antibodies and cross-immunity and other problems is easy
to be missed. With the spread of the epidemic, the number
of children gradually increased. The infection affected
premature infants and infants, and now there are severe
cases of children.14 At present, most of the confirmed cases
of children are declared to be cluster disease, i.e. “second-
generation” infection, and no clear reports of children as
the source of adult infection have been found. Beijing,
Guangdong and other places have seen a number of cases
of children infected with the new coronavirus, especially
on January 26, 2020, when a 9-month-old infant in
Beijing was infected through close family contact.14 The
transmission route in children is, similar to adults, mainly
by contact and respiratory droplets. Finding that most of
the infected children have aggregation, aerogel transmission
may also play a significant role in transmission. Careful
monitoring of the developmental stages of mothers who
become pregnant due to COVID-19 infection is needed,
as adverse maternal and child outcomes of COVID-19
pregnancies persist, and public health system surveillance
of the impact on infants and children is critical.
Seasonality
Although outbreaks and familial sexual transmission cases
have been described, little is known about the seasonality
of COVID-19.15 The scientists report that the new
coronavirus is most likely to become a seasonal respiratory
disease based on its current infectivity and lethality.
McGraw, a professor of infectious diseases at Penn state
university, believes that COVID-19 is more seasonal.16
It becomes more active in winter, when it enters people’s
bodies by droplets, and it spreads faster in cold and dry
air. Normal seasonal viruses usually cannot withstand
high temperatures, so once summer arrives, the virus
has basically zero infectivity when taken. On the other
hand, infectious disease expert Amesh Adalja disagrees
with McGraw, arguing that the evidence suggests it is
not seasonal because we have not seen the time of spring
and summer, and although its symptoms are somewhat
similar to seasonal flu that does not mean that it is really
a seasonal virus. Admittedly, the seasons can affect it,
but they do not necessarily make it disappear. As we all
know, our country is in the northern hemisphere; spring
temperatures are mild, which helps spread virus. However,
there have also been confirmed cases across the ocean
in the southern hemisphere, suggesting that the virus is
resistant. However, as the seasons change, it is possible
that the epidemic situation in China may weaken and the
crisis in the countries of the southern hemisphere may
intensify, although we do not know yet. Therefore, it is
too early to say whether the new coronavirus is seasonal.
We do not know much about it, there is no data to carry
out a comprehensive analysis, and everything should be
rigorous.
Clinical Characteristics
COVID-19 is usually associated with respiratory disease.
The most common symptoms associated with COVID-19
infection are fever, stuffy nose, and cough; However, the
Arch Iran Med, Volume 23, Issue 4, April 2020 269
Huang et al

Table 1. Summary of Clinical Characteristics of Patients Infected with COVID-19

Study Age Median No. Fever Rhinorrhea Cough Fatigue Headache Diarrhea Chest Tightness
Author
Location Range Age (y) Patients (%) (%) (%) (%) (%) (%) /Dyspnea (%)
Zhao et al, Guangxi,
11−68 45 28 18 (64) 2 (7) 12 (43) 7 (25) 4 (14) NA 3 (11)
202017 China
Guangzhou,
Yu et al,202018 33−62 50 91 70 (77) NA 57 (63) 19 (21) 11 (12) 5 (5) 5 (5)
China
Chen et al, Wuhan,
26−79 56 29 28 (97) NA 21 (72) 12 (41) 2 (7) 4 (14) 17 (59)
202019 China
Liu et al, Shenzhen,
10−72 63 12 10 (83) NA 11 (92) NA 0 (0) 2 (17) NA
202020 China
Tian et al, Beijing,
1−94 48 262 215 (82) NA 120 (46) 69 (26) 17 (6) NA 18 (7)
202021 China
Wang et al, Wuhan,
42−68 56 138 136 (99) NA 82 (59) 96 (70) 9 (7) 14 (10) 43 (31)
202022 China
Liu et al, Wuhan,
43−66 55 109 90 (83) NA 67 (61) 62 (57) NA 12 (11) NA
202023 China
Xu et al, Zhejiang,
32−52 41 62 48 (77) NA 50 (81) 32 (52) 21 (34) 3 (5) NA
202024 China
Chen et al, Wuhan,
21−82 56 99 82 (83) 4 (4) 81 (82) NA 8 (8) 2 (2) 2 (2)
202012 China
Yang et al, Wuhan,
NA 60 52 51 (98) 3 (6) 40 (77) NA 3 (6) NA 1 (2)
20204 China

virus has been associated with pneumonia.14 Symptoms of
clinical characteristics in patients infected with COVID-19
are frequently reported (Table 1).
Currently, it is believed that people are generally
susceptible to COVID-19, including pregnant women
and children. Most studies suggest that older middle-aged
people are more predisposed to COVID-19 (median age
of onset is about 55 years).24 Adults with COVID-19
infection most commonly manifest fever, cough and
fatigue, which in some patients can be accompanied by
runny nose, headache and other symptoms. Additional
symptoms such as diarrhea are less common. Respiratory
viruses can interact with each other and some bacteria
may affect susceptibility to acute respiratory diseases,
especially in patients with underlying immune deficiencies
or chronic respiratory diseases, such as chronic obstructive
pulmonary disease or cystic fibrosis.
In conclusions, the recent COVID-19 outbreak has
been deemed a global health emergency. Internationally,
the number of confirmed reports continue to rise.25
At present, China has listed COVID-19 as a class b
infectious disease stipulated by the law on prevention and
treatment of infectious diseases, and adopted an infectious
disease prevention. The basic strategy for controlling the
epidemic is early detection, early isolation, early diagnosis
and early treatment. COVID-19 cases are insidious and
transmissible in the incubation period, and multiple
clusters have been reported in China. The causal role of
COVID-19 in these cases is therefore uncertain and larger
studies are needed in the future to describe the prevalence,
clinical characteristics and course of the disease.26
Authors’ Contribution
All authors contributed significantly to both the study and the
manuscript. XH contributed to the data collection, data analysis
and wrote the draft of the manuscript. LH and LW prepared this
manuscript for publication. FW and KC took responsibility for the
integrity of the data analysis, and KC reviewed the manuscript. All
authors read and approved the final manuscript.
Conflict of Interest Disclosures
The authors declare that they have no competing interests.
Ethical Statement
The study was conducted as per the ethical principles of the
Helsinki Declaration.
Funding Sources
This work was supported by Longgang Science and Technology
Development Foundation (LGKCYLWS2019000791) and Shenzhen
Longgang Science and technology innovation Commission
(LGKCZSYS2018000010).
References
1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, et
al. Clinical features of patients infected with 2019 novel
coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-
506. doi: 10.1016/S0140-6736(20)30183-5.
2. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical
Characteristics of Coronavirus Disease 2019 in China. N Engl J
Med. 2020 Feb 28. doi: 10.1056/NEJMoa2002032.
3. Wang W, Tang J, Wei F. Updated understanding of the outbreak
of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J
Med Virol. 2020;92(4):441-447. doi: 10.1002/jmv.25689.
4. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical
course and outcomes of critically ill patients with SARS-
CoV-2 pneumonia in Wuhan, China: a single-centered,
retrospective, observational study. Lancet Respir Med. 2020
Feb 24. pii: S2213-2600(20)30079-5. doi: 10.1016/S2213-
2600(20)30079-5.
5. Sederdahl BK, Williams JV. Epidemiology and Clinical
Characteristics of Influenza C Virus. Viruses. 2020;12(1):E89.
doi: 10.3390/v12010089.
6. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al.
A pneumonia outbreak associated with a new coronavirus of
probable bat origin. Nature. 2020;579(7798):270-273. doi:
10.1038/s41586-020-2012-7.

270 Arch Iran Med, Volume 23, Issue 4, April 2020

Epidemiological characteristics of COVID-19
7. Su S, Li X, Hao H, Wang XY, Zhang MM, Geng H, et al.
Advances in research on SARS-CoV-2. Journal of Xi’an
Jiaotong University. 2020. Available from: http://kns.cnki.net/
kcms/detail/61.1339.R.20200224.0944.010.html.
8. Yang X, Miao C, Jin M, Jin M, Zhou D, Zhuang J, et al. Current
status and progress of 2019 novel coronavirus pneumonia.
Chinese Crit Care Med. 2020; 32(2):2095-4352. doi: 10.3760/
cma.j.issn.2095-4352.2020.02.000.
9. Chang L, Yan Y, Wang L. Coronavirus Disease 2019:
Coronaviruses and Blood Safety. Transfus Med Rev. 21
February 2020. doi: 10.1016/j.tmrv.2020.02.003
10. Ling L, Joynt GM, Lipman J, Constantin JM, Joannes-Boyau
O. COVID-19: a critical care perspective informed by lessons
learnt from other viral epidemics. Anaesth Crit Care Pain Med.
2020.doi: 10.1016/j.accpm.2020.02.002.
11. Wang Y, Kang H, Liu X, Tong Z. Combination of RT-qPCR
Testing and Clinical Features For Diagnosis of COVID-19
facilitates management of SARS-CoV-2 Outbreak. J Med Virol.
2020 Feb 25. doi: 10.1002/jmv.25721.
12. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al.
Epidemiological and clinical characteristics of 99 cases of
2019 novel coronavirus pneumonia in Wuhan, China: a
descriptive study. Lancet. 2020;395(10223):507-513. doi:
10.1016/S0140-6736(20)30211-7.
13. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson
DJ. Coronavirus Disease 2019 (COVID-19) and Pregnancy:
What obstetricians need to know. Am J Obstet Gynecol.
2020 Feb 24. pii: S0002-9378(20)30197-6. doi: 10.1016/j.
ajog.2020.02.017.
14. Fang F, Luo X. Facing a major outbreak of new coronavirus
infections in 2019: thoughts of pediatricians [J]. Chinese
Journal of Pediatrics. 2020;58(2):81-85. doi: 10.3760/
cma.j.issn.0578-1310. 2020.02.001.
15. Rodriguez-Morales AJ, MacGregor K, Kanagarajah S, Patel
D, Schlagenhauf P. Going global - Travel and the 2019 novel
coronavirus. Travel Med Infect Dis. 2020;33:101578.
16. Khan S, Ali A, Siddique R, Nabi G. Novel coronavirus is
putting the whole world on alert. J Hosp Infect. 2020. doi:
10.1016/j.jhin.2020.01.019.
17. Zhao R, Liang Y, Lin Y, Lu N, Li Q, Li Y, et al. Clinical
© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.
org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
characteristics of 28 patients with novel coronavirus
pneumonia. Chinese J Infect Dis. doi: 10.3760/cma.j.is
sn.1000-6680.2020.02.000.
18. Yu C, Zhai J, Zhang L, Jiang S, Chen B, Guan W, et al.
High resolution CT findings and clinical features of novel
coronavirus pneumonia in Guangzhou. Chinese Journal of
Radiology. doi: 10.3760/cma.j.issn.1005-1201.2020.0010.
19. Chen L, Liu H., Liu W, Liu J, Liu K. Analysis of clinical features
of 29 patients with 2019 novel coronavirus pneumonia.
Chinese Journal of Tuberculosis and Respiratory Diseases.
2020. doi: 10.3760/cma.j.issn.1001-0939.2020.0005.
20. Liu Y, Yang Y, Zhang C, Huang F, Wang F. Clinical and
biochemical indexes from 2019-nCoV infected patients linked
to viral loads and lung injury. Sci China Life Sci. 2020. doi:
10.1007/s11427-020-1643-8.
21. Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, et al.
Characteristics of COVID-19 infection in Beijing. J Infect.
2020. doi: 10.1016/j.jinf.2020.02.018.
22. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical
Characteristics of 138 Hospitalized Patients With 2019 Novel
Coronavirus-Infected Pneumonia in Wuhan, China. JAMA.
2020. doi: 10.1001/jama.2020.1585.
23. Liu Y, Sun W, Li J, Chen L, Wang Y, Zhang L, et al. Clinical
features and progression of acute respiratory distress
syndrome in coronavirus disease 2019. MedRxiv. 2020. doi:
10.1101/2020.02.17.20024166.
24. Xu XW, Wu XX, Jiang XG, Xu KJ, Ling LJ, Ma CL, et al.
Clinical findings in a group of patients infected with the 2019
novel coronavirus (SARS-Cov-2) outside of Wuhan, China:
retrospective case series. BMJ. 2020;368:m606. doi: 10.1136/
bmj.m606
25. Sohrabi C, Alsafi Z, O’Neill N, Khan M, Kerwan A, Al-Jabir a,
et al. World Health Organization declares Global Emergency:
A review of the 2019 Novel Coronavirus (COVID-19). Int J
Surg. 2020. doi: 10.1016/j.ijsu.2020.02.034.
26. Noori A, Shokoohi M, Moazen B, Moradi Gh, Naderimagham
Sh, Hajizadeh Sh, et al. National and sub-national burden of
infectious diseases in Iran, 1990 to 2013: The study protocol.
Arch Iran Med. 2014;17(3):169–175.
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